Provider Demographics
NPI:1215910310
Name:ROONEY, KEVIN J (PSYD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:ROONEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4116
Mailing Address - Country:US
Mailing Address - Phone:608-791-9555
Mailing Address - Fax:608-791-9432
Practice Address - Street 1:212 11TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4116
Practice Address - Country:US
Practice Address - Phone:608-791-9555
Practice Address - Fax:608-791-9432
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2272103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q32870Medicare UPIN